WASHINGTON — Approximately 86% of all battlefield deaths occur within the first 30 minutes after wounding. That is one reason why care administered even before wounded troops make it to a combat-casualty care hospital is so critical.

This phase of care, known as “prehospital care,” was a central theme at this year’s annual Advanced Technology Applications for Combat Casualty Care Conference (ATACCC) held in August in Fort Lauderdale, FL.

“Our first research frontier is to try to fill the gap in prehospital care,” said Col. Lorne Blackborne, commander of the U.S. Army Institute for Surgical Research, who pointed out that excessive bleeding is “the most common cause of potentially survivable deaths on the battlefield.”

Development of Freeze dried Plasma

Severe blood loss causes up to 50% of casualties who die on the battlefield, according to the Combat Casualty Care Research Program (CCCRP). The challenge is that treating blood loss requires the administration of red blood cells, plasma and platelets or their substitutes, all of which are temperature sensitive and difficult to store in remote locations. “We have as our No. 1 priority the development of a freeze-dried plasma,” said Dallas Hack, director of the CCCRP at the U.S. Army Medical and Materiel Command.

Plasma is currently supplied to the theater as a frozen product, which must be maintained at or below -20ºC during storage and requires shipping with dry ice. It then has to be thawed and refrigerated before use, limiting its shelf-life.

FDA trials are being conducted on products such as plasma that has been dried, either by freezing or by spray drying, said Hack, who said he would like to see a product like that available for use in theater. He acknowledged, however, that FDA approval of freeze-dried plasma is not imminent.

“The FDA does not consider it a blood product but biologic, so it has to go through a much more challenging approval process,” said Hack. “So the clinical trials to do that will probably take another three to four years. We had hoped to have it on the battlefield by now.”

Germany already has an approved freeze-dried blood product that is being used at a NATO hospital in Afghanistan where U.S. troops are treated, he said